Claim For Refund Sales Or Use Tax - Rhode Island Department Of Revenue

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STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF REVENUE
DIVISION OF TAXATION
ONE CAPITOL HILL
PROVIDENCE, RI 02908-5800
CLAIM FOR REFUND
SALES OR USE TAX
(PLEASE TYPE OR PRINT)
NAME
TELEPHONE NUMBER
STREET
CITY OR TOWN
STATE
ZIP CODE
SOCIAL SECURITY NUMBER
OR FEDERAL IDENTIFICATION NUMBER
A SOCIAL SECURITY NUMBER OR FEDERAL ID NUMBER MUST BE INDICATED ABOVE
IN ORDER TO PROCESS THIS CLAIM
TYPE OF CLAIM (circle one)
AUTOMOBILE CLAIMS
OTHER CLAIMS
REBATE
UTILITIES
TOTAL LOSS UNDER 120 DAYS
SOLAR
OTHER
PREPAID SALES TAX ON CIGARETTES
OTHER
AMOUNT OF TAX PAID _________________________ AMOUNT OF REFUND CLAIMED _________________________
STATE REASONS WHY CLAIM SHOULD BE ALLOWED: ____________________________________________________
ATTACH ALL SUPPORTING SCHEDULES AND/OR DOCUMENTS
CERTIFICATION
I hereby certify that I have personal knowledge of the information constituting this claim, including any
accompanying schedules and statements; that all statements contained herein are true, correct and
complete to the best of my knowledge and belief; and that this claim is made under penalty of perjury.
TAX DIVISION USE ONLY
SENT
SIGNATURE
RETURNED
AUDITED BY
TITLE (IF APPLICABLE)
AMOUNT APPROVED
DATE
DATE APPROVED

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